26 July 2012

Vaginal ring contraceptive may help migraines

A new study suggests a low dose of hormones from a vaginal ring contraceptive may lead to a decline in the incidence of migraine aura and a drastic cut in menstrual migraine.


 A new study suggests a low dose of hormones from a vaginal ring contraceptive may have two benefits for women with migraine: a decline in the incidence of migraine aura and a drastic cut in menstrual migraine.

"With these two very important findings, further research is clearly indicated to benefit women who suffer from either migraine with aura, menstrual migraine, or both," study leader Dr Anne Calhoun from the University of North Carolina in Chapel Hill said.

In the meantime, Dr Calhoun said, "I first urge caution. These were exciting results, but they came from a small observational study, intended as a pilot to guide future research. Good science requires larger and more rigorous trials before definitive conclusions can be reached."

How the study was done

The findings, from a review of data on 23 women who suffered from both menstrual migraine and migraine with aura, appeared online in Headache.

The patients used a transvaginal ring contraceptive with 0.120mg etonogestrel and 15mg ethinyl estradiol. Eight women used the ring without interruption, 15 used it for 12 weeks, followed by one week of transdermal 17-beta estradiol patches at 0.075mg.

The rate of migraine auras dropped from an average of 3.23 per month at baseline to a median of 0.23 per month after 7.8 months before follow up (p<0.0005). No patients reported an increase in auras. The treatment was also linked to the elimination of menstrual-related migraine in 91.3% of the patients.

An additional five women, who weren't included in the analysis, discontinued use of the ring within a month. Two stopped because of nausea, one for facial swelling, and two because of ring expulsion.

Current guidelines for treating migraine with warn against using combined hormonal contraceptives for fear of exacerbating the stroke risk, Dr Calhoun said. But on the other hand, aura itself is a risk factor stroke, and Dr Calhoun pointed out that the contraceptives appeared to reduce aura. Whether that means that the ring can also reduce the rate of stroke in patients with migraine aura should be the subject of future study, Dr Calhoun said.

The authors did not report any conflicts of interest.

(Reuters Health, July 2012)

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Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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